Combination of A-PRF and A Strip Free Keratinized Mucosal Graft for Increasing the Width of Keratinized Tissue Around Dental Implants: A Case Series

Abstract: Background: Insufficient width of keratinized tissue (KT) around dental implants is a potential contributing factor of peri-implant diseases, and soft tissue grafting procedures are recommended for long-term maintenance of dental implants. A bulk free keratinized mucosal graft (FKMG) from the hard palate in conjunction with an apically positioned flap (APF) is the gold standard for KT augmentation. However, the major shortcomings are limited sources of the grafts and risks of donor wound morbidity. This case series proposed an alternative approach for KT augmentation by the combination of advanced platelet-rich fibrin (A-PRF) with a strip FKMG. Material and methods: Two patients with insufficient peri-implant KT width (< 2mm) bilaterally were enrolled for the split-mouth observation. Two different surgical methods were utilized to augment KT in the same patient. The recipient bed was fully covered by a bulk FKMG on one side, and topical hemostatic agents were applied to the donor wound. A strip FKMG was placed at the apical border on the other side with the remaining recipient bed being covered by an A-PRF membrane, and the donor wound was protected by another A-PRF membrane. Results: All four treated sites exhibited 4-5 mm significant gain in KT width, and the width was maintained for 12 months. Compared with the surgeries using a bulk FKMG, patients reported lower postoperative pain scores with a strip FKMG and A-PRF combination. Conclusion: The combination of an A-PRF membrane and a FKMG strip demonstrated satisfactory short-term outcomes for peri-implant KT augmentation, and donor wound morbidity was reduced.